I
113th CONGRESS
1st Session
H. R. 2027
IN THE HOUSE OF REPRESENTATIVES
May 16, 2013
Mr. Sam Johnson of Texas (for himself, Mr. Hinojosa, Mr. Carson of Indiana, Ms. Jackson Lee, Ms. Jenkins, Mr. Marchant, Mr. Young of Indiana, Mr. Burgess, and Mr. Yoder) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend section 1877 of the Social Security Act to modify the requirements for hospitals to qualify for the rural provider and hospital exception to physician ownership or investment prohibition in order to take into account hospitals that were under construction or development at the time of imposing such requirements, hospital expansions, and hospitals in financial distress, and for other purposes.
Short title; table of contents
Short title
This Act may be cited
as the Expanding Patients’ Access to
Quality Care Act of 2013
.
Table of contents
The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Modification of Stark requirements for certain hospitals that were under construction or development as of December 30, 2010.
Sec. 3. Modifying Stark requirements for applicable hospitals to qualify for expansion of facility capacity.
Sec. 4. Additional exception for physician ownership and investment for hospitals in financial distress.
Modification of Stark requirements for certain hospitals that were under construction or development as of December 30, 2010
Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is amended—
in paragraph (1)(A)—
in the matter
preceding clause (i), by striking had
;
in clause (i), by
striking ; and
and inserting the following: , and had a
provider agreement under section 1866 in effect on such date or was under
construction or was under development (as defined in paragraph (7)(A)) on such
date; or
; and
by striking clause (ii);
in paragraph (1)(B), by inserting before
the period at the end the following: or if the hospital was under
construction or under development on December 31, 2010, no greater than the
number of operating rooms, procedure rooms, and beds for which the hospital is
licensed as of the date the hospital had a provider agreement in effect under
section 1866
;
in paragraph (1)(D)(i), by inserting before the period at the end the
following: or if the hospital was under construction or under
development on December 31, 2010, as of the date the hospital had a provider
agreement in effect under section 1866
;
in paragraph
(3)(C)(iii), by inserting after December 31, 2010,
the
following: or in the case of a hospital that did not have a provider
agreement in effect as of such date but was under construction or under
development on such date,
; and
by adding at the end the following new paragraph:
Definitions
For purposes of this subsection:
Under development
A hospital shall
be treated as being under development
on December 31, 2010, if
on or before such date the hospital—
submitted its enrollment application for a Medicare provider agreement;
had a binding written agreement with an outside, unrelated party for the actual design, construction, renovation, lease, or demolition for a hospital, and has expended at least 10 percent of the estimated cost of the project (or, if less, $1,000,000); or
obtained a certificate of need in a State where one is required.
.
Modifying Stark requirements for applicable hospitals to qualify for expansion of facility capacity
Section 1877(i)(3) of the Social Security Act (42 U.S.C. 1395nn(i)(3)) is amended—
by striking subparagraphs (A), (E), (F), (H), and (I);
by amending subparagraph (B) to read as follows:
Limitation on frequency of increases
A hospital may not effect an increase described in subparagraph (C) more often than once every 2 years.
;
in subparagraphs
(C) and (D), by striking an applicable hospital
and the
applicable hospital
and inserting a hospital
and
the hospital
, respectively, each place it appears;
in subparagraph (C)(i)—
by striking
granted an exception under the process described in subparagraph
(A)
;
by striking
has been granted a previous exception under this paragraph
and
inserting has had a previous increase under this subsection
;
and
by striking
such an exception
and inserting this paragraph
;
and
in subparagraph
(C)(ii), by striking The Secretary shall not permit an increase
in
and inserting A hospital may not increase
.
Additional exception for physician ownership and investment for hospitals in financial distress
Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is amended—
in paragraph (1)(A), as amended by section 2(1), by inserting after clause (i) the following new clause:
had a provider agreement under section 1866 in effect December 31, 2010, as of such date did not have physician ownership or investment, but after such date is determined to be in financial distress (as defined in paragraph (7)(B)).
;
in paragraph
(1)(D)(i), by inserting before the period at the end the following: ,
except that such percentage limitation shall not apply to a hospital determined
to be in financial distress (as defined in paragraph (7)(B))
; and
in paragraph (7), as added by section 2(5), by adding at the end the following new paragraph:
Financial distress
A hospital shall be
treated as being in financial distress
for a cost reporting
period if the Secretary determines that the hospital has had an overall
negative combined Medicare inpatient prospective payment system and outpatient
prospective payment system operating margin for the most recent 3 consecutive
cost reporting periods for which data are available. Once the Secretary makes a
determination that a hospital has such a negative operating margin for a cost
reporting period, the Secretary may not reverse such determination for such
period. A hospital that is treated as being in financial distress under this
subparagraph for a cost reporting period shall continue to be so treated for
all subsequent cost reporting periods as being in financial distress without
regard to changes in the hospital’s operating margin.
.